UNASSIGNED: Endoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression.
UNASSIGNED: We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery.
UNASSIGNED: The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.

UNASSIGNED: The indication for surgical optic canal decompression (OCD) for traumatic optic neuropathy (TON) remains controversial because there is no reliable predictor of a good outcome. We report the case of a blind patient with TON whose remaining visual-evoked potential (VEP) suggested recovery potential of the injured optic nerve after OCD.
UNASSIGNED: A 48-year-old man had fallen from a height of 7 m, striking his head. He immediately complained of right-eye blindness. He had no light perception and the direct light reflex disappeared from the right pupil, although there was no fracture or traumatic lesion on computed tomography and magnetic resonance imaging. Because the amplitude of the VEP with the right eye stimulation remained unchanged, we performed the right OCD. During surgical OCD, the amplitude and latency of VEP began to improve. Finally, the visual field improved in almost all directions, and eyesight improved to 0.2.
UNASSIGNED: The retained VEP activity in TON may suggest the recovery potential of the injured optic nerve, even in cases of blindness. It is possible that VEP is an indicator of aggressive treatment for TON such as OCD.

A case of visual impairment following craniomaxillofacial trauma is reported. The patient had sudden visual loss associated with fracture of the left orbital floor and medial and lateral wall of the left orbit and comminuted fracture of the left optic canal. Access to the orbit was achieved through the endoscopic endonasal approach and the bone fragments, which had impinged on the optic nerve, were resected. The patient had a total return of visual acuity without surgical complications. The role of orbital and optic decompression in the management of patients with traumatic optic neuropathy is discussed. The indication of orbital and optic decompression in the management of patients with traumatic optic neuropathy is controversial and the procedure should be considered only within the context of the specific needs of the individual patient.

The vision loss in the Traumatic Optic Neuropathy is the impact of deformational forces. This occurs due to direct or indirect injuries during trauma to skull. The use of high dose corticosteroids is the primary line of treatment in such injuries still remains a matter of debate. Traumatic Optic Neuropathy is yet an unexplored topic of study in Ayurveda. The Traumatic Optic Neuropathy can be correlated with Abhighatajanya Vataprakopaj Drishtinash. The treatment principles of Vataprakopaj Vyadhi are Snehan (massage), Swedan (sudation), Basti (enema) and Nasya (oleation through nasal route). A 50 year old male patient came to outpatient department suffered from motorcycle accident and had a forehead trauma followed by loss of vision in both eyes after 5 days and diagnosed as Traumatic Optic Neuropathy. An electrophysiological assessment showed absence of waveform in Visual Evoked Potential (VEP). According to Ayurveda patient was diagnosed primarily as Abhighatajanya Vataprakopaj Drishtinash and started to follow the protocol of Vataprakopaj Vyadhi. Patient received Ayurvedic formulations in morning, after meal and at night for 12 months and a course of Yapan Basti (medicated decoction enema) followed by Netratarpan (eye satiation), Nasya and Abhyanga (body and foot massage). Patient showed an improvement in the visual quality from no perception of light to perception of light and rays in right eye in 9 month. Patient had improvement in P100 latencies of right eye in VEP report and subjective improvement in quality of vision to perceive the images and objects. Application of Ayurvedic principles and Panchakarma therapy resulted in improvement of the case. An early management of Traumatic Optic Neuropathy with Ayurvedic treatment can have a significant impact on the clinical/visual outcome in terms of recovery in damaged optic nerve fibers.

UNASSIGNED: Optic nerve avulsion is a traumatic disinsertion of optic nerve fibres from the globe at the level of the lamina cribrosa. It is an uncommon and severe complication of blunt ocular trauma.
UNASSIGNED: We report the case of a 15 years old male presented to the emergency department after being kicked by a horse. Initial ophthalmologic examination of the left eye (LE), exhibited eyelid hematoma, subconjunctival hemorrhage, VA was limited to light perception and there was a left relative afferent pupillary defect. Dilated fundus examination of the LE revealed an extensive vitreous and preretinal hemorrhage overlaying the optic disc and retina edema.The diagnosis of LE optic nerve head avulsion (ONA) was made. Five years after the accident, VA of LE detecting hand motion, fundus examination revealed a superior dragging of the optic disc, fibroglial scarring, retinal vessel narrowing and retinal epithelium hyperplasia.
UNASSIGNED: In case of ONA, the avulsion can be missed initially due to vitreous and retinal hemorrhage overlaying the optic nerve, in such cases multimodal imaging can be a useful tool to the diagnosis and to evaluate associated ocular damage. Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA.
UNASSIGNED: Optic head nerve avulsion is a rare and severe disease and initial diagnosis is challenging due to associated media opacities. The prognosis is poor and the injury leads to permanent visual impairment.

Transorbital and intra-sphenoidal traumas are relatively uncommon, can be challenging to manage, and are associated with a high risk of complications and potentially fatal outcome. Transorbital and intra-sphenoidal trauma pose a medical challenge due to close relationship to delicate and critical anatomical structures, such as the globe, optic nerve, the ophthalmic internal carotid arteries, and central nervous system. Rapid admission to a level 1 trauma center with a high surgical expertise level is essential to ensure the best possible treatment and outcome. We present a case of a 75-year-old man who had a severe orbital trauma, where a wooden foreign object penetrated the orbit into the sphenoid sinus without penetrating its posterior wall. This case is important because of the rare trauma presentation with a wooden foreign object, which can easily be missed on computed tomography. The case also illustrates the importance of close collaboration between ophthalmologists and rhinologists when challenged with severe orbital sphenoid sinus trauma.

UNASSIGNED: Optical coherence tomography (OCT) is established as a promising technology for assessing the optic nerve atrophy progression after trauma. However, reports on the effectiveness and sensitivity of ganglion cell layer (GCL) and Bruch\'s membrane opening-minimum rim width (BMO-MRW) for studying this damage course over time are still lacking.
UNASSIGNED: A 53-year-old man with severe optic nerve trauma had repeated OCT scans of the retinal nerve fiber layer (RNFL), GCL and BMO-MRW during 12 months after the injury. There was gradual damage in all measurements. Interestingly, BMO-MRW was the first analysis affected whilst GCL showed the greatest damage over time.
UNASSIGNED: Our outcomes suggest that OCT might be able to assess axonal loss after traumatic optic neuropathy. BMO-MRW measurement might be more sensitive than other analyses in the first two weeks after trauma and GCL might better monitor belated damage. Thus, it might be possible to combine all these sets of measurements to increase diagnostic sensitivity an specificity.

We report a case of intraconal grease gun injury along with traumatic optic neuropathy in a 20-year-old male. He presented with dimness of vision and proptosis of the left eye (LE) following an accidental injury at work place. The computer tomography of orbit revealed hypodense grease orbit. Cream colored grease was continually exuding from the conjunctival wound. Patient improved rapidly after the surgical removal of the grease by anterior orbitotomy. Grease gun injuries to the orbit have rarely been reported. The present case is the eighth report throughout the world, and the first in India as per our knowledge.

We present our experience following a unique case of coincident intracranial hemorrhage and comminuted fractures of both the squamous temporal bone and zygomaticofrontal orbit. Surgical techniques and outcome for this presentation have yet to be sufficiently described. A 55-year-old male presented following trauma with Glasgow Coma Scale score of 7. Radiographic evaluation revealed comminuted fractures of the squamous temporal bone with extension into the lateral orbit, along with zygomatic process fracture extending 2.5 cm medially into the orbital roof. Zygomaticofrontal orbital roof fragments reached superiorly into the middle cranial fossa and inferiorly into the orbit. Surgical intervention was deemed necessary to address underlying epidural hematoma, subarachnoid hemorrhage, correction of cranial bone defects, and decompression of the optic nerve and other intraorbital nerves. A frontotemporal approach was employed. Repair of temporal and orbital fractures was accomplished using a combination of wire mesh screws and titanium miniplates. Postoperative imaging demonstrated bony approximation and successful evacuation of traumatic hemorrhage. The patient remains functionally and neurologically intact apart from a sluggishly responsive left eye presumed to result from a left optic nerve or ciliary ganglion lesion. Although rapid reconstruction of complex cranial-orbital trauma and hematoma evacuation can permit acceptable gross functional neurological outcome following massive trauma, orbital fracture and subsequent hemorrhagic processes may be the nidus of neurological sequelae in this complex traumatic constellation. Thus, alterations in surgical approach and reconstruction are appropriate in order to maximize neurological function while supporting restoration of cosmetic space.

BACKGROUND: Traumatic optic neuropathy (TON) is a form of optic nerve injury that occurs secondary to trauma and is etiologically associated with acute axonal loss with severe vision loss. Here, we reported longitudinal changes in the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) using wide-field swept source optical coherence tomography (SS-OCT) in two cases of TON and identified the source of the damage.
METHODS: (Case 1) A 65-year-old man was admitted to the hospital due to an injury in the right eye (OD) and was subsequently diagnosed with indirect TON. He was then treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 day, 2 days, 1 week, 1 month, and 4 months. The wide-field deviation map detected thinning earlier in the macular GCC than in the peripapillary RNFL. (Case 2) A 63-year-old man was admitted to the hospital with a fractured left maxilla-zygomatic complex attributed to blunt-force trauma to the head and loss of vision in his left eye (OS). He was diagnosed with indirect TON and treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 week, 2 weeks, 2 months 5 months, and 7 months. The wide-field deviation map detected thinning earlier in the peripapillary RNFL than in the macular GCC.
CONCLUSIONS: Wide-field SS-OCT facilitated the identification of various sequential progression patterns in patients with TON. Furthermore, the area in which the structural damage was first detected was seen differently in the peripapillary and macular deviation maps for each case. Thus, wide-field imaging, which includes the macular and peripapillary areas, are useful in monitoring TON.